<form id="frmModal" name="frmModal" action="<?php echo site_url(array('psdm','detachievement','ajax','save')) ?>" method="post">
<h3 class="dialog_title"><span>Add Detil Prestassi/Pelanggaran</span></h3>
<div class="dialog_content">
<div style="border-bottom: 1px solid #CCC; padding: 10px 0" >
<table width="100%" border="0" cellpadding="5" cellspacing="0">
	<tr>
		<td align="right">Nama:</td>
		<td><input type="text" name="inp[0]" class="validate['required']" maxlength="20" style="width: 150px" /></td>
	</tr>
	<tr>
		<td align="right">Jenis:</td>
		<td>
			<select name="inp[1]" class="validate['required']">
			<option value="">--- pilih ---</option>
			<?php foreach(array_keys($jenis_options) as $row):?>
				<option value="<?php echo $row?>"><?php echo $jenis_options[$row]?></option>
			<?php endforeach?>
			</select>
		</td>
	</tr>
	<tr>
		<td align="right">Bidang:</td>
		<td>
			<select name="inp[2]" class="validate['required']">
				<option value="">--- pilih ---</option>
			</select>
		</td>
	</tr>
	<tr>
		<td align="right">Tingkat:</td>
		<td>
			<select name="inp[3]" class="validate['required']">
				<option value="">--- pilih ---</option>
			</select>
		</td>
	</tr>
</table>
</div>
<div class="dialog_buttons" style="padding: 12px 10px">
	<input class="button" type="submit" value="Save"  />
	<input class="button" type="button" value="Cancel" onclick="FBModal_hide()" />
</div>
</div>
</form>